Owusu-Agyemang Pascal, Cata Juan P, Fournier Keith F, Zavala Acsa M, Soliz Jose, Hernandez Mike, Hayes-Jordan Andrea, Gottumukkala Vijaya
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
Ann Surg Oncol. 2016 Aug;23(8):2419-29. doi: 10.1245/s10434-016-5176-5. Epub 2016 Mar 14.
The aim of this study was to assess the impact of total intravenous anesthesia (TIVA) on the perioperative inflammatory profile and clinical outcomes of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).
A retrospective review of patients undergoing CRS-HIPEC was performed. Patients receiving a combination of preoperative tramadol extended release (ER), celecoxib, and pregabalin, along with combined intraoperative infusions of propofol, dexmedetomidine, lidocaine, and ketamine were classified as receiving a TIVA regimen (TIVA group). The second group consisted of patients receiving volatile-opioid-based anesthesia (VO group). The neutrophil:leukocyte (NLR) and platelet: leukocyte (PLR) ratios were calculated to evaluate the perioperative inflammatory status of both groups. Length of stay (LOS) and complications of both groups were also evaluated.
A total of 213 patients were included in the study-139 in the VO group and 74 in the TIVA group. No statistically significant differences were observed between the groups with regard to their postoperative inflammatory profiles, LOS, or complications by organ system; however, the incidence of renal complications was higher in the TIVA group (8.1 vs. 2.2 %) and approached statistical significance (p = 0.068).
In this retrospective study of patients undergoing CRS-HIPEC, the combined use of preoperative celecoxib, tramadol ER and pregabalin followed by intraoperative TIVA with infusions of propofol, dexmedetomidine, ketamine, and lidocaine was not associated with a reduction in LOS or complications by organ system. Postoperative NLR and PLR profiles were also not significantly impacted.
本研究旨在评估全静脉麻醉（TIVA）对接受减瘤手术联合热灌注化疗（CRS-HIPEC）患者围手术期炎症指标及临床结局的影响。
对接受CRS-HIPEC的患者进行回顾性研究。术前接受缓释曲马多、塞来昔布和普瑞巴林联合治疗，术中联合输注丙泊酚、右美托咪定、利多卡因和氯胺酮的患者被归类为接受TIVA方案（TIVA组）。第二组由接受挥发性阿片类麻醉的患者组成（VO组）。计算中性粒细胞与白细胞（NLR）比值和血小板与白细胞（PLR）比值，以评估两组患者围手术期的炎症状态。还评估了两组患者的住院时间（LOS）和并发症情况。
本研究共纳入213例患者，其中VO组139例，TIVA组74例。两组患者术后炎症指标、LOS或各器官系统并发症方面未观察到统计学显著差异；然而，TIVA组的肾脏并发症发生率较高（8.1%对2.2%），接近统计学显著性（p = 0.068）。
在这项针对接受CRS-HIPEC患者的回顾性研究中，术前使用塞来昔布、缓释曲马多和普瑞巴林，随后术中采用TIVA并输注丙泊酚、右美托咪定、氯胺酮和利多卡因，与住院时间缩短或各器官系统并发症减少无关。术后NLR和PLR指标也未受到显著影响。
